In 2013-2014, after adjustments for age, self-reported diabetes was highest in Mexican-Americans (15%) and non-Hispanic blacks (14% vs. 9% in non-Hispanic whites) and in those with obesity (15% vs. 6%).
With age adjustment, diabetes prevalence amongst participants > 60 years of age, defined by self-report, diabetes medication, and A1C >6.5%, has increased significantly from 20% in 1999-2000 to 25% in 2013-2014 (ptrend<.001).
Chart Explanation: The age-adjusted prevalence of self-reported diabetes among adults in 2013-2014 was only slightly higher in males than females (10.3% vs 9.6%). Mexican-Americans (15.2%) had a higher prevalence age-adjusted prevalence than non-Hispanic blacks (13.9%) or whites (8.6%). Age-adjusted prevalence amongst those with obesity 15.5%, compared to 6.2% in those without obesity.
The age-adjusted prevalence of diabetes as defined by self-report, diebetes medication, or measured A1C > 6.5% in the older U.S. adult population (age >60 years) has significantly increased from 1999-2000 to 2013-2014 (p-trend <.001).
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Controla and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Diabetes-associated nephropathy is one of the two main causes of CKD. Diabetic nephropathy accounts for 30-40% of CKD and 44% of incident ESRD in the United States (United States Renal Data System, 2011). Additionally, diabetes-related CKD is associated with high rates of morbidity and mortality (Foley et al., 2005; Go, Chertow, Fan, McCulloch, & Hsu, 2004). Thus, assessing the burden of this risk factor is essential to CKD surveillance. The NHANES surveys are currently conducted every 2 years by the CDC's National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized U.S. civilian residents. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES. Self-reported diabetes was defined by answer of “yes” to the question “have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” Glycohemoglobin, which was approved as a diagnostic test for diabetes in 2010 (American Diabetes Association, 2010), was measured in all participants; fasting glucose and oral glucose tolerance tests (2005-2016 only) were conducted in subsets of the NHANES participants. Medications were recorded from prescription bottles during the interview; metformin HCL, insulin, glimepiride, glipizide, glyburide, pioglitazone, rosiglitazone, meglitinides, DPP-4 inhibitors, GLP-1 receptors, SGLT2 inhibitors and any combination thereof were considered diabetes medications.
|Description of Measure||Prevalence of diabetes mellitus and glycemic control in the general population|
|Type of Data Source||Public|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Non-institutionalized U.S. residents aged 12+ years (20+ for adults)|
|Numerator||Non-pregnant participants with completed surveys or fasting glucose levels who report having diabetes (or with elevated fasting glucose)|
|Denominator||Non-pregnant participants with completed surveys (or fasting glucose levels)|
|Primary Data Source Indicator||diq010: “Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?” yes/no|
|Primary Indicator Method of Measurement||Questionnaire (interviewer-administered); ages 1+|
|Secondary (1) Variable||lbxglu: Fasting plasma glucose (subsample)|
|Secondary (1) Indicator Method of Measurement||Examination/Laboratory|
|Secondary (2) Variable||rhd143, rhd141/rhd140, urxpreg: current pregnancy|
|Secondary (2) Indicator Method of Measurement||Questionnaire (interviewer-administered) or exam (urine pregnancy status)|
|Secondary (3) Variable||nhcode/rxddrgid: generic drug codes|
|Secondary (3) Indicator Method of Measurement||Questionnaire (interviewer-administered), with recording of medications from Rx bottles|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||1999–2016|
|Additional Data Items of Interest||Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, hypertension by self-report)|
|Limitations of Indicator||Fasting plasma glucose only on a subsample of morning participants who were fasting; OGTT available for 2005-2014 only|
|Analytic Considerations||Appropriate NHANES survey weights, including fasting and OGTT weights, must be used for all analyses; glucose values must be converted for 2005-2006 and 2007-2008; OGTT only measured on those without diabetes|
|Age Adjustment||Adjusted for the distribution of age within the sample.|
References and Sources:
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
Foley RN, Murray AM, Li S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16(2):489-95.
National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD: National Institutes of Health; 2011.